Division of Hematology and Oncology, Medical University of South Carolina, 173 Ashley Ave, Suite 102 BSB, Charleston, SC 29425 USA.
Department of Pathology & Laboratory Medicine, Medical University of South Carolina, Charleston, SC USA.
J Immunother Cancer. 2016 Oct 18;4:63. doi: 10.1186/s40425-016-0167-4. eCollection 2016.
Malignancy after transplantation is an uncommon multifactorial occurrence. Immunosuppression to prevent graft rejection is described as a major risk factor in malignancy development in the post-transplant state. Donor-derived malignancy is a rare reported complication. Herein, we review our patient history and discuss diagnostic strategies and the implications of immunosuppression for donor-derived malignancy.
This is a 69-year-old man with post-renal-transplant urothelial carcinoma determined to be of donor origin. His course was complicated by BK virus at six years post-transplant; urothelial carcinoma was identified nine years post-transplant. Cystectomy was performed, but because of immunosuppression and underlying chronic kidney disease, the patient was considered ineligible for adjuvant chemotherapy. Two years after resection, screening MRI demonstrated retroperitoneal lymphadenopathy and a right upper pole mass in the transplanted kidney. Urine cytology confirmed the presence of malignant cells; FISH showed 2-8 copies of the X chromosome and no Y chromosome consistent with female origin of the malignant cells. CT-guided renal mass and paraaortic lymph node biopsies demonstrated that about 50 % of cells had an XY complement, while the remainder showed a XX genotype by chromosomal SNP microarray analysis. Immunosuppression was discontinued and the donor kidney removed. X/Y FISH of the urothelial carcinoma identified in the explanted kidney confirmed that the malignant cells were of female donor origin. Follow-up at 3, 6 and 12 months after discontinuation of immunosuppression and surgery demonstrated normalization of the lymphadenopathy and absence of new lesions.
Immunosuppression is a major risk factor for development of malignancy in transplant recipients. Donor-derived malignancy can arise and current molecular studies allow an accurate diagnosis. Withdrawal of immunosuppression and surgical resection of the transplant kidney proved an effective treatment in our case.
移植后发生的恶性肿瘤是一种罕见的多因素疾病。为了防止移植物排斥而进行的免疫抑制被描述为移植后状态下发生恶性肿瘤的一个主要危险因素。供体来源的恶性肿瘤是一种罕见的报道并发症。在此，我们回顾了我们的患者病史，并讨论了诊断策略以及免疫抑制对供体来源的恶性肿瘤的影响。
这是一名 69 岁的男性，在肾移植后患有确定为供体来源的尿路上皮癌。他在移植后六年出现 BK 病毒，九年后发现尿路上皮癌。进行了膀胱切除术，但由于免疫抑制和潜在的慢性肾脏病，该患者被认为不适合辅助化疗。切除两年后，筛查 MRI 显示腹膜后淋巴结肿大和移植肾的右上极肿块。尿液细胞学证实存在恶性细胞；FISH 显示 X 染色体有 2-8 个拷贝，没有 Y 染色体，符合恶性细胞的女性来源。CT 引导的肾肿块和腹主动脉旁淋巴结活检显示，约 50%的细胞具有 XY 染色体，而其余的细胞通过染色体 SNP 微阵列分析显示 XX 基因型。停止免疫抑制并切除供体肾。对移植肾中发现的尿路上皮癌进行 X/Y FISH 检测，证实恶性细胞来自女性供体。停止免疫抑制和手术后 3、6 和 12 个月的随访显示，淋巴结病正常化，没有新的病变。
免疫抑制是移植受者发生恶性肿瘤的一个主要危险因素。供体来源的恶性肿瘤可能发生，目前的分子研究可做出准确诊断。在我们的病例中，停用免疫抑制剂和切除移植肾被证明是一种有效的治疗方法。
